Health Questionnaire Name * First Name Last Name DOB * MM DD YYYY Age * Do you suffer with any heart problems? * No Yes Do you suffer with high or low blood pressure? * No Yes Do you suffer from Diabetes? * No Yes Do you have allergies or allergic to anything? * No Yes Do you suffer with any joint or mobility issues? * No Yes Have you been cleared by a GP to exercise if Pre or Post natal? No Yes Do you know of any reason why you should not exercise? No Yes If you have asnswerd YES to any of the above questions, please expand on your answer here. Emergency Contact Name. Emergency Phone Number (###) ### #### How fit or Unfit do you feel? 1 Walking to the fridge is hard work. 2 Sweat just eating a pizza. 3 Takes water brakes from the car to the house. 4 Can hit a 5000 steps by accident. 5 Need a motivational play list to climb the stairs 6 Can smash a 5k if there are tacos at the end. 7 You are the designated jar opener. 8 Loves taking active holidays. 9 Sleeps in full compression gear. 10 Spaniel on crack. Thank you!
